Prognostic role of FIGO stage, PCI, Fagotti score, HR status in patients with stage IIB-IV high-grade serous ovarian cancer after complete cytoreduction

High-grade serous ovarian carcinoma (HGSOC) is the most aggressive histological subtype of epithelial ovarian cancer and accounts for the majority of ovarian cancer-related deaths. Complete cytoreduction (R0) at primary debulking surgery (PDS) is well known as the most important factor in survival, but there is significant variation in outcome even among patients with no residual disease after surgery. This study evaluated the prognostic value of FIGO stage, PCI, Fagotti score and HR status in a surgically homogenous population of patients with advanced HGSOC (FIGO stage IIB - IV) undergoing complete cytoreduction with PDS. A total of 83 patients treated at the University Hospital of Padua from May 2019 to December 2025 were included. Among the preoperative parameters, HR status emerged as the strongest independent prognostic factor, with HRP/BRCA wild-type patients showing significantly shorter progression-free and overall survival compared to HRD/BRCA-mutated patients. FIGO stage was independently associated with progression-free survival, and PCI showed a significant association with PFS on log-rank analysis. There was no prognostic value in either survival endpoint for the Fagotti score. However, these findings suggest that even among patients achieving complete cytoreduction, molecular profile, disease stage, and preoperative tumour burden provide additional prognostic information and may improve postoperative risk stratification.